{extends file="./main.tpl"}
{block name=head}
{/block}
{block name=body}
<form name="driver" action="{$smarty.server.PHP_SELF}" method="post" onsubmit="return confirm('DO You Want To Submit !!!!!')";>
<table align="center" border="2" cellpadding="2" cellspacing="2" width="" >
<tr>
  <td align="center" class="table1" colspan="7"><b>Transport Cashmemo</b></td>
</tr>
<tr>
  <td class="table2" align="right">Consigner :</td>
  <td class="table2" align="left"><input type="text" name="consigner" autofocus /></td>
  <td class="table2" align="right">Cash Memo No. :</td>
  <td class="table2" colspan="3"><input type="text" name="cashmemono." required /></td>
  
</tr>
<tr>
	<td class="table2" align="right" colspan="">Consignee :</td>
  <td class="table2"><input type="text" name="consignee" ></td>
  <td class="table2" align="right" colspan="">Date :</td>
  <td class="table2" colspan="3">{html_select_date prefix="DepartureDate" start_year ="-0" end_year="+2" field_order="DMY" month_format="%m" day_value_format="%02d"}</td>
</tr>

<tr>
  <td class="table2" align="right">Lorry Freight :</td>
  <td class="table2" align="left"><input type="text" name="lorryfreight" /></td>
  <td class="table2" align="right">Octroi No.:</td>
  <td class="table2" colspan="3"><input type="text" name="octroino." ></td>
  
</tr>
<tr>
	<td class="table2" align="right" colspan="">Octroi :</td>
  <td class="table2"><input type="text" name="octroi" ></td>
  <td class="table2" align="right" colspan="">G. C. Note No. :</td>
  <td class="table2"><input type="text" name="gcnoteno" ></td>
  <td class="table2" align="right" colspan="">Description :</td>
  <td class="table2"><textarea id="" name="description" ></textarea></td>
</tr>
<tr>
  <td class="table2" align="right">Service Charges :</td>
  <td class="table2" align="left" colspan="6"><input type="text" name="servicechargest" /></td>
  
</tr>
<tr>
	<td class="table2" align="right" colspan="">Form Charges :</td>
  <td class="table2"><input type="text" name="formcharges"></td>
  <td class="table2" align="right" colspan="">Form :</td>
  <td class="table2">
    <select name="truckNo" id="truckNo" />
    <option value="">Select From List</option>
	  </select>
  <td class="table2" align="right">To :</td>
  <td class="table2" align="left" colspan=""><input type="text" name="to" ></td>
</tr>
<tr>
	<td class="table2" align="right" colspan="">Hamali :</td>
  <td class="table2" colspan="5"><input type="text" name="hamali" ></td>  
</tr>
<tr>
	<td class="table2" align="right" colspan="">I. C. Charges :</td>
  <td class="table2" colspan="5"><input type="text" name="iccharges" ></td>
</tr>
<tr>
	<td class="table2" align="right" colspan="">Demmurage :</td>
  <td class="table2" colspan="5"><input type="text" name="demmurage" ></td> 
</tr>
<tr>
	<td class="table2" align="right" colspan="">Total :</td>
  <td class="table2" colspan="5"><input type="text" name="total" ></td>
  </tr>
<tr>
	<td class="table2" align="right" colspan="">S. T. @ % :</td>
  <td class="table2" colspan="5"><input type="text" name="st@%" ></td>    
</tr>
<tr>
	<td class="table2" align="right" colspan="">Grand Total :</td>
  <td class="table2"><input type="text" name="grandtotal" ></td>
  <td class="table2" align="right" colspan="">Received From M/s :</td>
  <td class="table2" colspan="3"><textarea id="" name="receivedfromm/s" ></textarea></td>
</tr>
<tr>
	<td class="table2" align="" colspan="3">Amount :</td>
  <td class="table2" colspan=""><input type="text" name="amount" ></td>
  <td class="table2" align="right" colspan="">Sign :</td>
  <td class="table2" colspan=""><input type="text" name="sign" ></td>
</tr>
<tr>
  <td class="table1" align="center" colspan="7"><input type="submit" name="insertBtn" value="Submit" class="button" /></td>
</tr>
</table>
</form>
{/block}